Anaphylaxis is a severe, potentially fatal allergic reaction. Food allergy is the most common cause of anaphylaxis, although several other allergens – insect stings, medications, or latex – are other potential triggers.

“Anaphylactic shock” is a term that specifically refers to an episode of anaphylaxis where the person goes into a state of shock due to poor blood circulation that deprives the body of oxygen and nutrients.

FARE recently announced the appointment of James R. Baker, Jr., MD as chief executive officer and chief medical officer. Jim has been serving as interim CEO since the departure of FARE’s previous CEO, John Lehr, at the end of August. He has served on FARE’s Research Advisory Board for a number of years, helping set the research strategy for the organization and reviewing research proposals. A board-certified allergist and accomplished researcher with more than three decades in the field, Jim has been instrumental in the development and execution of “A Vision and Plan for Food Allergy Research,” FARE’s ambitious strategic plan for advancing the field of food allergy research published in 2013. He also has been a strong advocate for improving food allergy education, promoting food allergy advocacy initiatives and increasing awareness of the potentially life-threatening nature of food allergies. We asked Jim to tell us a bit more about himself and his vision for FARE in this interview:

Tell us a bit about your background.

Probably the most relevant part of my background is the fact that I’ve been an allergist for almost 35 years and spent 20 years running allergy and immunology at the University of Michigan. My decision to become an allergist was based on my fascination with the immune system. The immune system is the only part of the human body that you could actually educate; after an infection or a vaccine, you can teach the immune system to protect itself against something new. The immune system has almost unlimited capability to evolve and protect itself against multiple types of infections, and this was remarkable to me. My quest to understand the intricate workings of the immune system drove me to specialize in allergy and immunology, and to do basic research on the immune system and vaccines.

One of my biggest concerns when I first became an allergist was that there would be no illnesses to treat as my career advanced. The knowledge of the immune system was advancing so rapidly I believed that many of the fundamental diseases of the immune system, like allergies, would be fully defined and treatable within a decade or two. Paradoxically, however, at the same time our knowledge of the immune system increased, the complexity of human immune disease grew at a more rapid rate. Allergies are now much more common than they were 30 years ago, and food allergies in particular have become extremely common. The reason for this explosion in allergic disease is not clear and is one of the most pressing problems in human research today. It is this problem that keeps me fully engaged as a physician.

How did you become involved with FARE?

I became involved with FARE because of my background in immunology and because of my recognition of food allergy as such a pressing problem. I was working with both FAI and FAAN (the Food Allergy Initiative and the Food Allergy & Anaphylaxis Network, FARE’s legacy organizations) and had started our own Food Allergy Center at the University of Michigan. Through this I interacted with many of the board members of these organizations, and I was impressed with their vision for a national advocacy organization for food allergy. I was invited to join the Research Advisory Board and worked with many of FARE’s staff. When they approached me to help them in an interim position as chief medical officer, I felt honored and truly enjoyed the experience. I was fortunate to be asked to serve as the interim and now permanent CEO for an organization that I feel is full of terrific people with an incredibly important mission.

What do you see as FARE’s most important priorities in supporting the food allergy community and advancing the field of food allergy research?

FARE’s major initiatives are to help ensure that people with food allergies can live safe, productive lives with the respect of others and have access to state-of-the-art healthcare while providing them with hope for better therapies for the disease. Food allergy won’t be cured quickly and we must make sure that people with food allergies are able to live normal lives in the meantime. Our education and advocacy initiatives are focused on making sure individuals can safely access and engage in a full range of life activities regardless of their food allergy. Finally, we need to encourage and support research that provides an understanding of the basis of food allergies and develops new treatments that reduce the risk of life-threatening reactions.

What do you hope to accomplish in your tenure as FARE’s CEO?

First, I hope to improve the lifestyle of patients with food allergy through education and advocacy efforts that will ensure improved understanding of the disease and better accommodations for the 15 million Americans with food allergies. I also want to help identify physicians who are focused on treating and helping patients with food allergies so that the individuals we serve will know where to go for help. Finally, I hope to engage the pharmaceutical industry to develop and test drugs to treat food allergies. This includes encouraging them to test drugs that have proved useful for other allergic diseases in food allergy.

If you could look 10 years into the future, what progress do you think we will see in the field of food allergy?

While I think finding a cure for food allergy is a long-term goal, I believe that over the next few years we will have medications to treat patients with food allergies that go beyond simply treating anaphylaxis once it is occurring. Many diseases do not have cures, but they do have therapies that allow people to accommodate their illness. If we could achieve the same type of effective therapy for food allergy, the lives of patients would be markedly improved and we could focus on the underlying causes for the disease.

Before the start of the 2012-2013 school year, epinephrine auto-injectors (EAIs) were distributed to all schools in the Chicago Public School (CPS) system, the third largest school district in the U.S. Data on the use of these unassigned auto-injectors was collected and reviewed by a team of researchers, led by Ruchi S. Gupta, MD (Northwestern University Feinberg School of Medicine, Chicago), a member of FARE’s Medical Advisory Board. Their study, published online by the American Journal of Preventive Medicine on Oct. 22, found that 38 auto-injectors were used during the school year, and that:

Peanut was the most common food allergen (18 percent), followed by fin fish (13 percent)

In more than a third of the reactions, the trigger was unknown (34 percent)

Elementary schools had the most cases of EAI administration (63 percent)

In most cases (76 percent), school nurses administered the medication

This study underscores the need for school access to epinephrine, one of FARE’s advocacy priorities. FARE was instrumental in helping pass the Illinois stock epinephrine law (both in 2011 and a revision in 2014) and was part of the team that helped CPS develop its stock epinephrine guidelines. You can help advance our national stock epinephrine work and other key advocacy initiatives by joining the FARE Advocates Network.

The Teal Pumpkin Project is now a nationwide movement, but it started with one mom and her support group in Tennessee. Becky Basalone, leader of the Food Allergy Community of East Tennessee (FACET), had the idea for the concept of using a teal pumpkin to signify handing out non-food treats two years ago, and local families quickly embraced the tradition.

This year, FARE partnered with Becky to take her idea to the masses, amplifying her idea for how we can make Halloween more inclusive for kids with food allergies. We are thrilled to use our national platform and resources to support and organize this campaign.

To tell you more about the origins of the Teal Pumpkin Project, here is FARE’s interview with Becky, the mom who started it all:

Tell us about yourself and your family.

My family lives in East Tennessee and we have always been very involved in our local community. We are truly blessed to have an extremely supportive network of family members and friends. In 2012, testing revealed that my youngest son’s health condition was failing due to food allergies and anaphylaxis. He was first diagnosed with life-threatening food allergies to cow’s milk, peanut, all tree nuts, shellfish, cinnamon and apple, and intolerances to several food preservatives. He has since outgrown his cow’s milk allergy. As an infant, my oldest son (now age 7) had issues with cow’s milk and other foods but was never diagnosed with a true allergy. It is believed now that he has outgrown FPIES and has the current diagnosis of milk intolerance. I, too, have life-threatening food allergies to tree nuts and several members of my extended family also manage food allergies.

Our mission is to improve the social aspect of food allergy through support, education, and advocacy as a group of individuals and families affected by food allergies and anaphylaxis. We recognize the need to raise public awareness of food allergy in our community, public institutions and restaurants.

Tell us about how you came up with the idea to paint a pumpkin teal and use it to signify that non-food treats were available at homes in support of kids with food allergies.

My youngest son, age 2 at the time, was diagnosed with multiple life-threatening food allergies in 2012. To connect more with local families, I started a food allergy support group, the Food Allergy Community of East Tennessee – more commonly known in our area as FACET. Our small support group attended an Allergy-Friendly Trunk or Treat sponsored by our allergist and my family painted a teal pumpkin as part of our trunk décor. We passed out non-food items and contact cards for FACET. Afterwards, my oldest son, age 5 then, placed the pumpkin on our front porch and we were prepared to pass out the same treats to our neighborhood trick-or-treaters. We provided the option to choose from a bowl of candy treats or a bowl of safe “tricks” for those that visited our home … and we met several other families managing food allergies in our area. The kids loved having the opportunity to choose a safe trick or treat. This became a Halloween tradition for our family to provide both – and my sons believed that this made sense because the neighborhood visitors always ask “Trick or Treat” at the door. Our “trick” bowl contained an assortment of items like spider rings, googley-eye glasses, crayons, coloring sheets, slime, boxes of Band-Aids, stickers, wind-up toys, matchbox cars, hair accessories, eye patches, glow sticks, etc.

FACET had grown to approximately 50 families by 2013 and we were a FARE-recognized support group when we decided to launch a program we called “Food Allergy Awareness Pumpkins” through our local support group efforts. Amanda Painter and I made flyers and posters encouraging participants to paint a pumpkin teal or hang a sign on the door indicating that non-food treats are also available. We made sure to educate about the need to keep the candy separate to avoid cross-contact. This would allow children with food allergies and other dietary restrictions to safely participate in the fun of traditional trick-or-treating on Halloween. We did not wish to exclude candy, but instead wanted to add another option of a safe alternative to be available. My friend and fellow support group leader, Jennifer Addington, of the Northeast Georgia Food Allergy Support Group shared our Facebook post on Twitter and it took off on both social media sites. This caught the attention of other support group leaders and FARE’s leadership team. We are so appreciative of FARE and an amazing network of support groups across the nation in helping to promote this project this year.

As a local support group leader, you typically focus on food allergies in your city and state – how does it feel to have this idea spread nationwide?

I absolutely LOVE that the Teal Pumpkin Project has been welcomed as a new tradition for families across the nation. As a parent, I pray that my actions have a positive impact on my children but I had never imagined that this act of love would reach so far and impact so many. It is definitely accomplishing its mission of raising awareness and it has united the food allergy community to stand strong in support of our children.

When was the first moment that you realized just how big the Teal Pumpkin Project had gotten? Why do you think it caught on like it has?

As soon as FARE released the Teal Pumpkin Project on their website, we received such wonderful feedback from parents in every state. It was amazing to see how excited advocates and parents were to spread the news about the project and rally local communities to get involved. If I were to pinpoint an actual moment that made me realize just how significant this project had become, it would be when CNN provided coverage of the Teal Pumpkin Project and stated that FARE’s first Facebook post reached 2.7 million people in less than 72 hours. To reach that many people so quickly was absolutely amazing for food allergy awareness!

I think it has caught on so quickly because families managing food allergies need to feel more of a positive connection to others in their communities. I also think that the general public is eager to participate because most realize that this is a simple compassionate act that can make a huge difference to a child. As a support group leader, I know that so many families are in great need of support, especially when dealing with the anxiety that comes with wanting your child to experience childhood without fear of social implications or health risks. This is just a fun project to safely include each child, get everyone involved and begin the conversation about food allergies in a positive way.

It is awesome to think that a teal pumpkin on a porch (or a sign on the door) may unite a few neighboring families, help build a support network between parents, and create a feeling of inclusion for a child with food allergies.

Thank you for taking the time to highlight and promote our awareness efforts. It is amazing how far this project has reached.

On behalf of FARE and families across the country – thank you, Becky! You can learn more about the Teal Pumpkin Project on the FARE website, and check out our map to see how far the idea has spread!

At least 15 percent of people with food allergies develop the condition after the age of 18, a new study suggests. Our understanding of the prevalence and characteristics of food allergy have been based mostly on studies examining the condition in children. In contrast, this study, published in JACI: In Practice in August 2014, revealed new information about many aspects of adult-onset food allergy, including age of onset and most common allergic triggers. Read more about these findings on our blog.

Researchers from Chicago’s Northwestern University Feinberg School of Medicine reviewed medical records from a database of 1,111 patients who had been diagnosed with food allergy by physicians at Northwestern’s adult allergy clinics. They determined that 171 patients met criteria that included age at the time of diagnosis, medical history, test results, and international diagnosis codes. Based on an assessment of these patients, the researchers found that:

The age of first reaction peaked during the early 30s, with patients’ ages ranging from 18-86 years. Another important finding was that an older age at the time of diagnosis was associated with higher risk for severe reactions. In addition:

A higher percentage of the patients were female, which contrasts with the male dominance of food allergy in children.

The five most common food allergies among this group were shellfish, tree nuts, fish, soy and peanut. Study participants also identified 14 other foods as allergic triggers.

Approximately 16% of patients were allergic to more than one food.

Although the researchers state that additional studies are needed to provide “a more complete picture of this patient group,” they note that these findings support the importance of understanding food allergy in adults, “particularly in understanding that new-onset food allergy is evident across a broad age range during adulthood.”

FARE is thrilled that so many families across the country are planning to participate in the Teal Pumpkin Project! The idea is simple –pick up some inexpensive toys (ideas can be found on our website), paint a pumpkin teal and place it and a free, downloadable sign from FARE in front of your home to show that you have non-food treats to hand out.

The campaign has been tremendously popular on social media – reaching nearly 5 million people on Facebook – and has been featured by national and local media across the country. Here are just a few of the articles, news clips, and radio spots that have helped promote this fantastic campaign for inclusion:

In 2014, FARE awarded more than $135,000 in grant support to 60 communities across the country to advance food allergy education, advocacy and awareness efforts as part of FARE’s 2014 Community Outreach Grants program. With these grants, FARE helps local food allergy leaders – support group leaders and FARE Walk for Food Allergy chairs – develop programs that will result in a better understanding of food allergies within their local communities. Grant recipient Anne Russell, who used FARE grant funding to hold the Food Allergy & Anaphylaxis Michigan Conference this summer, shares her experiencing with coordinating one of six regional food allergy conferences that are being held this year on with support from FARE grants.

Vision. Donors. Teamwork. These are several of the key factors contributing to the success of the Food Allergy & Anaphylaxis Michigan Conference (FAAMC) held Aug. 9, 2014. With more than 20 years of diverse experience in the field of food allergy, including many years of creating educational seminars on this topic, it was exciting to again provide food allergy public health education.

Critical Timing for MichiganFAAMC occurred at an important time in Michigan as the state mandate for school stock epinephrine and anaphylaxis training for school staff began this fall. Delivering quality programming by credentialed professionals was vital with the intensified need for evidence-based information.

Management & Planning TeamThe FAAMC management and planning team was comprised of five experienced registered nurses and two educators who kindly donated time and professional expertise. This team of health care professionals also developed the FAAMC program. Madonna University College of Nursing and Health generously donated services and wonderful conference space. Concordia University Ann Arbor assisted with obtaining continuing education credits for teachers.

Local Support GroupsUpon reaching out to coordinators of local food allergy support groups, their excitement about FAAMC was inspiring! They spread the word about FAAMC to their groups. They were also FAAMC exhibitors and helped with set-up and take-down on conference day.

FARE’s Community Outreach GrantThanks to the Community Outreach Grants (COG) program by FARE, I was able to apply for and receive sponsorship for FAAMC. The COG program is open to support group coordinators and fundraising walk chairs – neither of which I am. So, the Circle of Food Allergic Families support group offered to include my grant proposal with that of their own group and fortunately, both were approved.

Speakers & TopicsThe exceptional FAAMC speaker line-up included allergists, registered nurses, a dietician, an attorney and a teacher. Sessions covered food allergy basics, daily home management, nutrition, school food allergy management and a research update. More than 200 people were present – including great exhibitors. School staff and medical professionals from across the state, New York and Ohio attended. About half the audience was parents/caregivers. Feedback was very positive with the vast majority indicating on evaluation forms they would attend again.

Thank you FARE!

The generosity of many people contributed to the success of FAAMC. Thanks to FAAMC sponsors, conference admission was free. Registered nurses and teachers seeking continuing education credits only paid a small fee. FARE’s COG program made a difference in what FAAMC was able to offer. FARE’s sponsorship was significant in extending the reach of quality food allergy and anaphylaxis public health education.

Milk allergy should not be confused with lactose intolerance. Milk allergy is a food allergy, which is an overreaction of the immune system to a specific food protein. When the food protein is ingested, it can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, etc.). Reactions to milk can be severe and life-threatening (read more about anaphylaxis).

Milk allergy is sometimes referred to as dairy allergy, but this term should be used with caution. Dairy is a category of products that contain cow’s milk. Since this is a product category – not a single ingredient (such as milk) – it is not listed in ingredient statements on processed foods. The Food Allergen Labeling and Consumer Protection Act requires that products containing milk list it as an ingredient, and so when teaching others about this allergy, using the term milk instead of dairy can help them better read ingredient labels. The term “dairy allergy” can also cause confusion with egg allergy since eggs are usually located near the dairy product case in the grocery store. Using the specific term – milk allergy – helps to eliminate this confusion.

Unlike food allergies, food intolerances do not involve the immune system. People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products. As a result, individuals who are lactose intolerant are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating and diarrhea. While lactose intolerance can cause great discomfort, it is not life-threatening.

A new study published in JACI: In Practice finds that patients who visit an allergist/immunologist after being treated for anaphylaxis in the emergency department (ED) receive a more accurate diagnosis, which can lead to more effective management of their allergy. This is the first study to examine how a follow-up visit affects outcomes in patients who receive emergency treatment for potentially life-threatening reactions.

Ronna L. Campbell, M.D., Ph.D., and colleagues at the Mayo Clinic (Rochester, Minn.) analyzed the records of 573 patients who were evaluated in an ED for an anaphylactic reaction. After their ED visit, 217 patients followed up with an allergist/immunologist. Most of these patients (67 percent) underwent some type of testing. Anaphylaxis was ruled out in 16 patients. The allergist/immunologist was able to identify the trigger of the reaction in 74 patients whose trigger was unknown after evaluation in the ED. Of the 143 patients who had a suspected trigger during their ED evaluation, nine had a different trigger identified during the follow-up visit. The most common trigger identified by the allergist/immunologist was food, followed by medication.

Overall, after evaluation by an allergist/immunologist, either the diagnosis of anaphylaxis or the identification of the trigger of the reaction was changed in 77 patients. In addition, four patients were diagnosed with a mast cell activation disorder. “These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis,” the authors conclude. Improving follow-up rates, they add, would help ensure that anaphylaxis triggers are identified accurately. Helping patients understand exactly which triggers to avoid decreases the risk of re-exposure to allergens and prevents unnecessary avoidance. In addition, patients can benefit from additional education and advice, including assistance in developing an anaphylaxis action plan and completing documentation for school, work or travel.

This Halloween, FARE is encouraging food allergy families to start a new tradition: painting a pumpkin teal and placing it on your porch as a sign to other families managing food allergies that you have non-food treats available at your home. Your teal pumpkin is also a way to raise awareness in your neighborhood about food allergies!

Purchasing inexpensive non-food treats to hand out is a great way to include all children in trick-or-treating, and we hope that the Teal Pumpkin Project will be a tradition for years to come.

Examples of non-food items include: glow bracelets or necklaces, pencils, markers, boxes of crayons, erasers, bubbles, mini Slinkies, whistles or noisemakers, bouncy balls, coins, spider rings, vampire teeth, mini notepads, playing cards, bookmarks, stickers, and stencils. Oriental Trading or Amazon are websites used by many parents to order these items (Visit smile.amazon.com to shop on Amazon and donate a portion of your purchases to FARE. Just search for “Food Allergy Research & Education”). Please note: Links in this paragraph are not sponsored and are provided as a resource, not as an endorsement.

Print out FARE’s teal pumpkin poster to post next to your door to notify visitors that you are handing out non-food items in support of all children with food allergies.

For those with pumpkin allergies, you can paint a plastic pumpkin. Painting a plastic pumpkin is also a way to reuse the same pumpkin year after year. Acrylic or spray paints are recommended, and those with milk allergies should avoid using milk paint. For instructions on how to paint a pumpkin, view this wikiHow tutorial.

FARE would like to thank the Food Allergy Community of East Tennessee (FACET) for this wonderful idea. We are pleased to bring it to the attention of families across the country, and we hope you will join in our effort to make Halloween more inclusive for children with food allergies!

If you have additional ideas for non-food treats, please leave a comment!